GASTROINTESTINAL

SYSTEM
PROCEDURES

Gary D. Morrison, M.Ed., R.T.(R)

Associate Professor, Radiologic Sciences
Midwestern State University

GASTROINTESTINAL
SYSTEM PROCEDURES
¾ Similarities
Comparable densities requires use of
contrast media.
Require use of fluoroscopy.
Technologist also uses overhead tube to
produce plain films.
¾ Variables
Structures vary greatly in shape, size, and
location depending on body habitus.
Great variation in “normal” function.

GASTROINTESTINAL
SYSTEM PROCEDURES
¾ Contrast Media
Positive
D Barium Sulfate (BaSO4).
—Most common
—Can not be used with perforation
—Suspension not solution
D Non-injectible,
water-soluble Iodine (Oral) -
generally used when barium is contraindicated.
Negative
D Normally air or CO2.
D Used to give double-contrast.

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 GASTROINTESTINAL
SYSTEM PROCEDURES
¾ Contrast Media
Mixing of Barium
D Thin
—Used for UGI & SBS
—Moves faster - actual speed depends on
suspending media temperature, consistency, &
condition of GI tract
D Thick
—Used to coat (barium swallow & BE)
—Moves slowly
D Barium must be stirred before use
D Exact thickness will be determined by the
radiologist & dept. protocol

GASTROINTESTINAL
SYSTEM PROCEDURES
¾ Contrast Media
Contraindications/Alternates
D The use of barium is contraindicated in the
following:
—Perforated viscous
—Pre-op
D When barium is contraindicated, use non-
injectible, water-soluble Iodine (Oral) contrast
—Gastrografin
—Oral Hypaque
D Barium can cake in GI tract
—Force fluids
—Use laxatives & enemas as necessary

GASTROINTESTINAL
SYSTEM PROCEDURES

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 GI SYSTEM PROCEDURES -
ESOPHAGRAM (BARIUM SWALLOW)
¾ Examination of
Pharynx (distal 2/3)
Esophagus
¾ Looks at
Anatomical structure
Swallowing function
¾ Patient Preparation
No prep
Pt. removes clothing, jewelry, glasses, &
dentures

GI SYSTEM PROCEDURES -
ESOPHAGRAM (BARIUM SWALLOW)
¾ Room Preparation
Room clean
Barium mixed - thick & thin
Fluoro set up
Spot film cassettes/cameras
ready
Table in upright position with
foot board in place

GI SYSTEM PROCEDURES -
ESOPHAGRAM (BARIUM SWALLOW)
¾ Fluoro Routine
General survey of chest & abdomen
Deglutition observed
D Upright
D PA/AP
D Obliques

Recumbent
Optional
D Trendelenburg
D Valsalva
D Water test
D Toe-touch

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 GI SYSTEM PROCEDURES -
ESOPHAGRAM (BARIUM SWALLOW)

¾ Overhead Routine
Use thick Barium
Upright or recumbent
Standard positions
D RAO
D PA/AP
D Lt. Lateral

GI SYSTEM PROCEDURES -
ESOPHAGRAM (BARIUM SWALLOW)
¾ RAO
MSP 35°- 40° to film
CR 2” lat. Of MSP
Shield gonads

GI SYSTEM PROCEDURES -
ESOPHAGRAM (BARIUM SWALLOW)
¾ PA/AP
Center MSP to film
Arms at side
Turn head slightly
Shield gonads

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 GI SYSTEM PROCEDURES -
ESOPHAGRAM (BARIUM SWALLOW)
¾ Lt. Lateral
Arms forward
Center MSP to film
CR - T5-T6
Shield gonads

GI SYSTEM PROCEDURES -
CARDIAC SERIES
¾ To Determine the Size & Shape of the
Heart.
¾ No Fluoro
¾ Thick Barium
¾ 72” FFD - Erect
¾ Four (4) Positions
PA
Lt.. Lateral
45o RAO
60o LAO

GI SYSTEM PROCEDURES -
UPPER GI SERIES (UGI)
¾ Examination of Distal Esophagus,
Stomach, & Duodenum
¾ Patient Preparation
NPO for 8-12 hours
D No smoking
D No gum chewing
For exam, patient must remove clothing,
jewelry, glasses, & dentures
¾ Room Preparation - As Previously
Discussed

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 GI SYSTEM PROCEDURES -
UPPER GI SERIES (UGI)
¾ Fluoro Routine - Generally Starts As for
the Barium Swallow & Then Progresses
According to Radiologist & Dept. Protocol
¾ Overhead Routine - Completed After
Fluoro According to Radiologist & Dept.
Protocol
RAO
PA
Rt. Lateral
LPO

GI SYSTEM PROCEDURES -
UPPER GI SERIES (UGI)
¾ RAO - 40°- 70°
Varies with size, shape, & position of
stomach
Shield gonads

GI SYSTEM PROCEDURES -
UPPER GI SERIES (UGI)
¾ PA
CR-mid-way between spine & Lt. lat. border
at level of L1-L2
Shield gonads

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 GI SYSTEM PROCEDURES -
UPPER GI SERIES (UGI)
¾ Rt. Lateral
CR - midway between MCP & ant. Border at
level of L1-L2
Shield gonads

GI SYSTEM PROCEDURES -
UPPER GI SERIES (UGI)
¾ LPO - 45° (30°- 60°)
CR-mid way between spine & Lt. lat. border
at level of L1-L2
Shield gonads

GI SYSTEM PROCEDURES -
SMALL BOWEL SERIES
¾ To Study Radiographically the Structure
& Function of the Three Parts of the
Small Intestine & to Detect Abnormalities
¾ Patient Preparation
Light meal night before
NPO for 8-12 hours
No smoking or gum chewing
Laxative or enema (optional)
For exam, patient must remove clothing -
including underwear

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 GI SYSTEM PROCEDURES -
SMALL BOWEL SERIES
¾ Indications
Enteritis - inflammation of the mucousal &
submucousal tissues of the intestines
Neoplasms - a new & abnormal formation of
tissue which serves no useful function
D Benign
D Malignant

Various malabsorption syndromes

Ileus - obstruction
D Adynamic/Paralytic
D Mechanical

GI SYSTEM PROCEDURES -
SMALL BOWEL SERIES
¾ Contraindications
Perforation
Pre-op
Large intestine obstruction
¾ May Be Performed As
Small bowel series only
UGI with small bowel follow-through
Accelerated small bowel - cold saline
Small bowel enema (enteroclysis)
Retrograde small bowel - reflux method

GI SYSTEM PROCEDURES -
SMALL BOWEL SERIES
¾ Imaging
Overheads
D films at 30 min. intervals until barium reaches
ileocecal valve
(usually 2 hrs.)
D CR - MSP at level of
L2 for early films, iliac
crest for delayed films
Fluoro & spot films
D optional
D when barium reaches
the ileocecal valve

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 GI SYSTEM PROCEDURES -
BARIUM ENEMA
¾ To Study the Structure & Function of the
Large Intestines & Detect Abnormalities
¾ Indications
Appendicitis
Colitis - inflammation of the colon
Diverticulosis/itis - outpouching of bowel
wall/with inflammation
Intussusception - collapse of bowel into itself
Neoplasm - benign or malignant
Volvulus - twisting of bowel on itself

GI SYSTEM PROCEDURES -
BARIUM ENEMA
¾ Patient Preparation
Same as UGI, plus
Laxative - mandatory
D Types
—Irritant - castor oil
—Saline-based magnesium
citrate or magnesium sulfate
D Contraindications
—GI bleeding
—Diarrhea
—Obstruction
—Inflammatory lesions
Cleansing enema - optional

GI SYSTEM PROCEDURES -
BARIUM ENEMA
¾ Contrast Media
Single - Positive, usually Barium
Double
D Used to show small growths such as polyps
D Positive & negative, usually Barium & Air
¾ Contrast Media Administration
Closed-bag system
D Self-contained
D Disposable
D Allows mixing of Barium
D Allows for drainage

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 GI SYSTEM PROCEDURES -
BARIUM ENEMA

¾ Contrast Media Administration

Open system
D Reusable
D Blood-body fluid hazard
D Spill hazard
Enema tips & rectal tubes
D Straight- disposable
D Retention tip - disposable
D Rectal catheter with balloon - reusable

GI SYSTEM PROCEDURES -
BARIUM ENEMA
¾ Room Preparation
Table horizontal - footboard optional
Bucky tray at foot of table
Barium mixed according to protocol
Fluoro tower set up with overhead tube out
of the way
Spot film cassettes/camera ready
Good supply of gloves & towels
Mop & bucket

GI SYSTEM PROCEDURES -
BARIUM ENEMA
¾ General Routine
Prepare the patient
D Explain the exam
—Encourage relaxation
—Deep breaths through mouth
D Have pt. change - everything
Scout
Insert enema tip
D Explain
D Sims position
D Lubricate tip

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 GI SYSTEM PROCEDURES -
BARIUM ENEMA

¾ Fluoro Routine
Maintain tension on enema tip
Communicate
Turn barium on & off
Change spot films
Fluoro routine will vary with
radiologist & institution

GI SYSTEM PROCEDURES -
BARIUM ENEMA

¾ Overhead Routine
Single contrast BE - completed after fluoro
D AP/PA projection
D RAO position
D LAO position
D AP/PA axial projection
D OPTIONAL - Rt. &/or Lt. Lateral
D Post-evacuation AP/PA projection

GI SYSTEM PROCEDURES -
BARIUM ENEMA
¾ AP/PA Projection
CR - MSP at level of iliac crest
Shield gonads

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 GI SYSTEM PROCEDURES -
BARIUM ENEMA
¾ RAO - 35°- 45°
CR - 1”-2” lat. to midline on elevated side at
level of iliac crest
Shield gonads

GI SYSTEM PROCEDURES -
BARIUM ENEMA
¾ LAO - 35°- 45°
CR - 1”-2” lat. to midline on elevated side
at level of iliac crest
Shield gonads

GI SYSTEM PROCEDURES -
BARIUM ENEMA
¾ AP/PA Axial
AP - CR - 30°- 40° cephalad at MSP & ASIS
PA -CR - 30°- 40° caudal at MSP & ASIS

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 GI SYSTEM PROCEDURES -
BARIUM ENEMA
¾ Lateral Rectum
CR - MCP at level of ASIS

GI SYSTEM PROCEDURES -
BARIUM ENEMA
¾ Post-evacuation
Same as AP/PA

GI SYSTEM PROCEDURES -
BARIUM ENEMA WITH AIR

¾ Overhead Routine
BE with air (double contrast) - completed
after fluoro for instillation of air
D Repeat all or part of single-contrast routine, plus
D AP/PA projection - both
D Rt. Lateral Decubitus position
D Lt. Lateral Decubitus position

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 GI SYSTEM PROCEDURES -
BARIUM ENEMA WITH AIR
¾ Rt. Lat. Decubitus
Horizontal CR at
MSP & iliac crest

GI SYSTEM PROCEDURES -
BARIUM ENEMA WITH AIR
¾ Rt. Lat. Decubitus
Horizontal CR at
MSP & iliac crest

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